Healthcare Provider Details

I. General information

NPI: 1902385487
Provider Name (Legal Business Name): TRINCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N PACIFIC ST
MINEOLA TX
75773-1836
US

IV. Provider business mailing address

908 N PACIFIC ST
MINEOLA TX
75773-1836
US

V. Phone/Fax

Practice location:
  • Phone: 903-569-2244
  • Fax:
Mailing address:
  • Phone: 903-569-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIAS DAVID FAJARDO
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 903-510-1113